OUTCOMES BY RACE AND ETHNICITY IN TWO DIFFERENT CARE MODELS FOR ACUTE APPENDICITIS

Authors:
Leo Andrew Benedict

Body of Abstract:
Background: Despite the use of standardized clinical pathways for acute surgical diseases, disparities in population-specific outcomes persist. Our tertiary care center developed an Acute Care Surgery (ACS) perioperative clinical pathway for patients diagnosed with acute appendicitis to standardize care delivery and enhance efficiency. The impact of the pathway on reducing or exacerbating racial and ethnic disparities in surgical outcomes is unknown.

Methods: This retrospective cohort study involved consecutive patients admitted to our tertiary care facility with acute appendicitis who underwent appendectomy. Demographic and clinical data were abstracted from patient medical records. White, Black, and Hispanic patients were classified by pre- (January 1, 2016-July 31, 2018) and post-initiation (August 1, 2018-December 31, 2023) of the ACS clinical pathway. Outcomes, including post-operative LOS (primary), recovery room discharge rates and time from computed tomography (CT) to operating room (OR), were analyzed using Negative Binomial regression with an interaction between race and clinical pathway, adjusted for age and perforation. Statistical analysis was performed using SAS with a p-value <0.05 determined as significant. Results: Of 705 consecutive patients, 220 (31%) were treated prior to implementing the ACS pathway. Overall, 532 (75%) were White, 88 (12%) were Hispanic, and 85 (12%) were Black, with relatively similar distributions before and after the ACS pathway was introduced. In adjusted analyses, there was an interaction for LOS, with White, but not Black or Hispanic, patients experiencing a shorter LOS with the new pathway (p=.03, Figure 1). Improvements in discharge from the recovery room (p=.40) and CT to OR time (p=.39) was similar across all demographic groups after introducing the ACS pathway (Figure 1). Conclusion: While a new ACS clinical pathway improved a range of outcomes, White patients had a greater improvement in shorter post-operative LOS than Black or Hispanic patients. Further prospective investigation into the factors associated with disparate post-operative LOS improvements among non-White race groups and solutions to mitigate barriers to timely discharge is warranted.